A Doctor Writes – Using Improved Communication to Redesign Services

Published: 2nd November 2016

As part of our recently released benchmarking work, our Clinical Lead, Dr David Griffiths, spoke with 6 consultants from 6 different specialties in 6 different Trusts about their experiences using Consultant Connect. In this first of two blogs he summarises his thoughts on how improving communication between GPs and hospital specialists can lay the foundations for redesigning how services are delivered.

In my role offering clinical advice to the team at Consultant Connect, I have been trying to understand what makes the service work well in general and what things might make it better. I have been lucky enough to speak to a range of consultants who use the service, both as clinicians but also as system leaders. Their thoughts are generally very similar and instructive.

IMPROVED COMMUNICATION

One common comment among the consultants I spoke with was that hospital staff are under pressure to avoid admissions. The same is true for primary care clinicians of course and, yet, the purchaser-provider split was identified as one of the causes of a ‘them and us’ attitude on both sides.

A clear theme has been how difficult communication between primary and secondary care has become in the current NHS, in contrast to times gone by: “dysfunction has crept into the system”. Although many services try hard to maintain their approachability, I heard about a reality where GPs leave messages on the answerphones of harassed secretaries while consultants “struggle to prioritise email”, “take longer to type their responses” and “can’t have the sort of nuanced discussion I have on the phone”.

Where phone advice is offered in traditional systems, it may rely on the consultant on-call fitting it around other activities in an extremely busy week. The “immediacy [of Consultant Connect] is very helpful” as is “the simplicity [for GPs] of a single number to connect” and “the convenience of the call coming through to a mobile so that you don’t have to answer if you’re doing something else”. Similarly, “knowing there is a pool of people who can respond takes the pressure off” consultants.

Telephone Advice & Guidance, I was told, “puts GPs and consultants back together”, “it is enjoyable having that direct contact” as “voice to voice is so much better than bits of paper floating around”.

The workload issues were not felt to be significant: “it is actually a modest number of calls, so it ought to be manageable” and when consultants begin using the service “they find it is not actually that onerous” as, often, what is required is a “quick answer to a simple question”. Consultants who do use the service generally find their GP colleagues appreciative – one clinical director told me of a GP who described it as “the best thing [the hospital] has done in 25 years”.

SERVICE REDESIGN

Moving forward, the improved communication arising out of immediate telephone contact between GPs and consultants will be a key enabler for Trusts to redesign and improve their services.

As Consultant Connect embeds in these Trusts, the local leaders I spoke with see it as “a clear advantage” in the development of new models of care – it hasn’t “made the referral process easier but it has refined it”. As these new models of care will almost certainly be community based, the need for “sound communication is paramount”.

Another potential positive, when designing future systems, is the ability to “redirect work into the right areas. For example, instead of admitting a patient, directing the patient to an urgent clinic makes a big difference for staff”. This is one of the key benefits of a system that is local – enabling clinicians to access useful information on effectively navigating the local system. If a GP is speaking to a consultant in a different locality they are less likely to receive useful advice about how to navigate their own system. The challenge, therefore, is knowing how to increase the scale of the service beyond local boundaries (making it more robust through having access to a larger group of clinicians) whilst keeping the benefits of local system knowledge.

One consultant was so impressed with the impact of Consultant Connect, he tells colleagues “Get with it. This is clearly the way forward. I haven’t come across anything which has made such a difference in managing planned care in medicine”.

If you would like to learn more about implementing telephone Advice and Guidance in your area, please contact us on 01865 261467 or by email on info@www.consultantconnect.org.uk.